Walking into Mercy's Emergency Department as the Director of Nursing more than a year and a half ago, I was tasked to meet three specific outcomes: improve patient satisfaction, increase overall productivity and decrease staff overtime. After spending the first several months collecting and reviewing data as well as collaborating with the medical director, I began building a process known as "Team Care" in our department. While we did experience great success in the three aforementioned areas, we also managed to reduce our turnaround time to discharge (TAT-D) by 20 percent.
The first step in this process was to rebuild our shift times. We discovered that we had a number of staff on at various times of the day when our census was low. We eliminated and recreated shift times so that we could have more staff available when we were busy.
In our old system, one nurse was assigned to three or four patients, while techs served 12 to 14 patients apiece. We developed a system in which every eight patients have two nurses and one tech caring for them. This allowed more people to interact with each patient, improving the patient's perception of teamwork in our department. Additionally, we began having a team member, preferably an RN, available and at the bedside with the provider during the initial evaluation and during the disposition of the patient. While this was originally developed so that patients would experience us working together as a team, we unexpectedly found it has also reduced our TAT-D time by 20 percent. A simple enough plan, but this concept really paved the way for our Team Care model by putting our staff in a position to succeed as a team.
The 20 percent drop in TAT-D appears to come from many different sources. Patients are rarely left alone and thus get their questions answered more quickly. In addition, engaging the nurses raises their participation and understanding and helps them to both anticipate patient needs and to gather data that the provider requires for treatment and disposition. Finally, being at the bedside with the providers during patient evaluation and disposition raises the nurses' overall awareness of patient needs, which allows the nurses to be more efficient and to manage their time more effectively.
When we began Team Care more than a year ago, we developed a very structured process and expected staff members to follow it. But what we were hoping for in the long run was a culture change. We wanted to create an environment that would enable staff to help whichever patient was most in need at that moment. Today we are seeing that change take place. While staff members are still assigned to teams, they now go beyond their assignments to help other staff members, providers and patients to whom they are not assigned. We are beginning to see a change in culture which will allow us to grow as a department, as a hospital and as leaders in health care, while providing safe, quality care and excellent service to our patients and community.